Drug advisory panel to get an overhaul: Abbott

By Pamela Fayerman, Vancouver SunFebruary 12, 2009

VANCOUVER — A University of B.C.-based panel of experts that advises the B.C. government and others on pharmaceutical products will be overhauled after getting mixed results in an expert review, Health Minister George Abbott said Wednesday.

But Abbott said the government will not withdraw support for the Therapeutics Initiative (IT), which dispenses information not only to the government, but also to doctors, pharmacists and health-care consumers.

The review was commissioned by UBC medical school dean Gavin Stuart, who said he wants to implement its recommendations.

“We do need a body which can provide us with the best, most thoughtful, science- and evidence-based information on which to base our decisions for our pharmaceutical formularies,” Abbott said.

The government uses that information to decide which drugs are included for coverage by PharmaCare.

“The review highlights the strengths and weaknesses of the TI and provides a road map for going forward to improve things like its transparency and inclusiveness,” Abbott said.

No decision have been made as to whether the TI needs more funding to do its job, he said.

The TI is part of the UBC department of anesthesiology, pharmacology and therapeutics and has been funded by the government for 14 years with an annual budget of about $1 million. It reviews about 20 drugs per year for the government. Safety, clinical and cost-effectiveness are included in the reviews.

The review team consisted of Jean Gray, a professor emeritus at Dalhousie University; Dr. David Henry, president of the Ontario-based Institute for Evaluative Sciences; Dr. Lisa Dolovich of McMaster University; and Dr. Bas Masri, a surgeon and head of orthopedics at UBC.

While the review team found the TI is highly reputed around the world for its research and education, it also found evidence of a lack of transparency, perceived conflicts of interest, lack of consultation processes and low output of original research.

“The current TI has experienced misinterpretation and misunderstanding. For this reason, the current structure of the TI cannot continue,” the review report stated.

It found that doctors are polarized in their opinions of the TI. Family doctors appreciated the objective reviews it publishes on the safety and effectiveness of medications, while specialist physicians believed the reviews are too restrictive and ignore practising doctors’ clinical judgment.

As well, the review found, there is a misconception that the TI is biased in favour of government cost-cutting measures and that it plays a bigger role than it actually does in what drugs PharmaCare approves for coverage.

The review found no evidence to substantiate that perception. It found that the TI process is pure and uses “best knowledge” and “best available” evidence. It said the TI does not tell the government which drugs to cover; it provides only a summary of the evidence.

As to whether the TI relies too much on randomized, controlled studies and not enough on other sources of information, the review team said there was “some substance” to the complaints that the consultation process has been limited. The report suggests the TI should do more collaboration with the other academic drug evaluation groups around the country.

Among other recommendations:

• The TI should remain at UBC and should be funded by UBC, not by the government.

• The TI needs more than $1 million a year to be more productive.

• The pharmaceutical industry should be allowed to review assessment reports for factual errors. Reports should be released publicly so that there is no secrecy.

• There should be no voting members on the government’s drug review committee if they have also been involved in the drug assessment process. Currently, there is one such member.

• The TI should be made up of three sections: drug evaluation, pharmaco-epidemiology for post-marketing surveillance of medications, and education.

• Other funding sources should be sought, such as grants and endowments.

• Communications must improve to avoid the misperceptions that have “plagued the TI.”

• The TI brand around the world should not be destroyed and the government should stay out of the educational arena with respect to medications.

Stuart said he was pleased with the review and wants to implement all the recommendations in the next year.

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